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2078 Initial Results of a First-in-Human, Phase I Study Point-of-Care Manufacturing of Trispecific CAR-T Cells Targeting CD19/20/22 in B-Cell Malignancies

Program: Oral and Poster Abstracts
Session: 704. Cellular Immunotherapies: Early Phase Clinical Trials and Toxicities: Poster I
Hematology Disease Topics & Pathways:
Research, Clinical trials, Clinical Research, Chimeric Antigen Receptor (CAR)-T Cell Therapies, Cell expansion, Treatment Considerations, Biological therapies, Technology and Procedures
Saturday, December 7, 2024, 5:30 PM-7:30 PM

Sumithira Vasu, MD, MBBS1, Evandro Bezerra, MD2, Nathan Denlinger, DO, MS2, Nicole Szuminski1*, Dina Schneider, PhD3, Pradyot Dash, PhD4, Louisa Wirthlin5*, Narendranath Epperla, MD, MS6, Yazeed Sawalha, MD2, Jennifer A. Woyach, MD7, Kerry A. Rogers, MD2, Seema A Bhat, MD2, Gregory K Behbehani, MD, PhD8, Karilyn T. Larkin, MD8, Adam S Kittai, MD9, Wing Chan, PhD10, Ashley Angell Krull11*, Shamama Nishat, PhD1*, Lynn O'Donnell, PhD1*, Lapo Alinari, MD, Ph.D10 and Marcos de Lima, MD12

1The Ohio State University, Columbus, OH
2Division of Hematology, The Ohio State University, Columbus, OH
3Lentigen, Gaithersburg, MD
4Lentigen, a Miltenyi Biotec Company, Gaithersburg, MD
5Miltenyi Biotec, Gaithersburg, MD
6Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH
7Division of Hematology, Ohio State University Comprehensive Cancer Center, Columbus, OH
8Division of Hematology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
9Icahn School of Medicine at Mount Sinai, New York, NY
10James Comprehensive Cancer Center, The Ohio State University, Columbus, OH
11The Ohio State University Wexner Medical Center, Columbus, OH
12Department of Internal Medicine, Division of Hematology, The Ohio State University - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH

Introduction: Targeting CD19, 20, 22 which are ubiquitously expressed on B-cell malignancies may decrease the risk of antigen-negative and antigen positive relapses. Our preliminary data showed feasibility of in-house manufacturing of Trispecific CAR-Ts and confirmed their specificity and killing activity in in vitro and in vivo B-cell lymphoma models. Here we report the results of a first-in-human phase I study evaluating Trispecific CAR-T cells targeting CD19, 20 or 22 (NCT05418088).

Methods: The duoCAR20.19.22D94 (Lentigen Technology, Inc) designed for Trispecific targeting of CD19, CD20, and CD22 is comprised of two separate CAR molecules co-expressed in each transduced T cell: a tandem second-generation CAR comprised of scFv targeting antigens CD20 and CD19, respectively, hinge and transmembrane domain derived from CD8, OX40 co-stimulatory domain, and CD3ζ activation domain, and a first generation CD22-targeting CAR with anti CD22 scFv binder domain, CD8- derived hinge and transmembrane domains and CD3ζ activation domain. Manufacturing of Trispecific CAR-T cells utilized the Miltenyi DuoCAR lentiviral vector, and CliniMACS Prodigy device using TransAct T cell reagent. The day after apheresis, both manufacturing and lymphodepleting chemotherapy (Cyclophosphamide 60mg/kg IV on day -6, Fludarabine 25mg/m2 IV on days -5 to -3) was initiated. Protocol initially allowed CAR-naïve patients and was later amended to include Commercial CD19 CAR-T failures. Cohort A included B-cell NHL with lesions < 5 cm, CLL, B-PLL and utilized a fresh product. Cohort B included B-ALL, Richter’s transformation (RT) and B-cell NHL with lesions > 5cm. 40% of the CAR-T product was infused as a fresh infusion on day 0 and the remainder was infused as a cryopreserved product on day +7. Prophylactic tocilizumab was administered 30 minutes prior to receiving CAR-T cells for both cohorts. There were three dose levels (DL): 0.5 x 10e6/kg, 1.0x 10e6/kg and 2.0 x 10e6/kg.

Results: 17 patients were eligible and 16 started lymphodepleting chemotherapy. Successful product manufacturing was achieved in 15/16 patients. One patient had a manufacturing failure following apheresis and subsequent recollection also resulted in unsuccessful manufacturing. Median transduction efficiency was 26% (range: 11.25%-43.1%), and median fold expansion was 5 (range: 1.81- 11.46). Median time to manufacturing was 7 days (range: 6-10 days). Cohort A included 3 patients with CLL, 1 with B-PLL, 1 with DLBCL and 1 with FL. Cohort B included 2 patients with DLBCL, 3 with RT, 2 had ALL, 2 had MCL and 1 had lymphoid blast crisis from CML.

Out of 15 patients, CR was achieved at day 30 in 2 patients, by day 90 in 4 patients, with a total of 6 patients who achieved CR. CR was observed in MCL, FL, DLBCL and B-ALL. Among 9 NHL (3 with RT) patients, 5 patients achieved CR and 3/5 remain in CR beyond 1 year post CAR-T. CR was seen at dose level (DL) 1 (n=2), DL 2 (n=2) and DL3 (n=2). Response was noted in a B-ALL patient who had progressed after commercial CD19 CART. CRS was seen in 3 patients, max grade 2 (2 patients G1, 1 patient G2) and 3 patients required tocilizumab, ICANS Grade 1 was seen in 1 patient. No HLH was observed. None of the patients required steroids. One death was observed from intracranial hemorrhage in a B-ALL patient with persistent disease at day 32. No responses were observed in Richter’s transformation. Stable disease was observed at day 30 in CLL and B-PLL. Two patients in CR developed other malignancies- one pleomorphic sarcoma and prostate cancer, both deemed unrelated to Trispecific CAR-T.

Of those who relapsed, 3 patients had a biopsy to evaluate CD19, 20 or 22 expression pre-and post CAR-T. In one patient, CD20 positivity changed to CD20 dim expression upon relapse. In another patient, CD20 negative status changed to CD20 + after CAR-T. We studied persistence data of circulating Trispecific CAR-T cells using PCR. We measured a maximum of 600 copies per ng DNA by day 20, with the highest levels of expansion detected in the higher dose levels.

Conclusions: Initial results from this first-in-human Trispecific CAR-T targeting CD19/20/22 show feasibility of manufacturing and that the product is safe with very low incidence of CRS/ICANS and no HLH. Despite lack of persistence of cells beyond day 30, durable remissions have been observed. Remissions have been observed in MCL, FL, DLBCL and B-ALL. Further investigations into mechanisms of response vs. resistance are ongoing.

Disclosures: Vasu: Alexion Inc: Other: Advisory Board; Sanofi Inc: Research Funding; Lentigen/Miltenyi Biotec: Research Funding. Bezerra: Kite Therapeutics: Honoraria, Other: Advisory Board; Novartis: Honoraria, Other: Advisory Board; Kyverna Inc: Honoraria, Other: Advisory Board, . Denlinger: Bristol Myers Squibb: Research Funding; Miltenyi Biotec: Other: Advisory Board. Schneider: Lentigen Technology, a Miltenyi Biotec Company: Current Employment. Dash: Lentigen, a Miltenyi Biotec Company: Current Employment. Wirthlin: Lentigen, a Miltenyi Biotec Company: Current Employment. Epperla: Novartis: Consultancy; Beigene: Speakers Bureau; Genetech: Speakers Bureau; Ispen: Other: Advisory Board; Lilly: Other: Advisory Board. Sawalha: Genmab: Honoraria, Research Funding; AbbVie: Research Funding; ADC: Consultancy; Beigene: Research Funding. Woyach: Loxo Lilly: Consultancy; Janssen: Research Funding; Genentech, Inc.: Consultancy; BeiGene: Consultancy; Merck: Consultancy; Pharmacyclics: Consultancy, Research Funding; Newave: Consultancy; AstraZeneca: Consultancy; AbbVie: Research Funding; Schrodinger: Research Funding; Morphosys: Research Funding. Rogers: Janssen Biotech Inc, Pharmacyclics LLC, an AbbVie Company: Membership on an entity's Board of Directors or advisory committees; AbbVie Inc, Genentech, a member of the Roche Group, Novartis: Research Funding; AbbVie Inc, BeiGene Ltd, Genentech, a member of the Roche Group, Janssen Biotech Inc, Loxo Oncology Inc, a wholly owned subsidiary of Eli Lilly & Company, Pharmacyclics LLC, an AbbVie Company: Consultancy; AstraZeneca Pharmaceuticals LP.: Membership on an entity's Board of Directors or advisory committees. Bhat: AstraZeneca: Consultancy, Research Funding. Kittai: BeiGene: Consultancy, Research Funding, Speakers Bureau; AstraZeneca: Consultancy, Research Funding, Speakers Bureau; Abbvie: Consultancy; BMS: Consultancy; Galapagos: Consultancy; Eli-Lilly: Consultancy. Chan: Xellera Therapeutics: Consultancy; Cellperior Process LLC: Current equity holder in private company. de Lima: Lentigen, a Miltenyi Biotec Company: Research Funding.

*signifies non-member of ASH